The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance

Abstract

Objectives: Patient non-attendance and dropout remains problematic in mental health settings [1,2]. The Theory of Planned Behaviour (TPB) has proved useful in understanding such challenges in a variety of healthcare settings, but the absence of an adequate measure has hampered research in mental health. The aim of the current study was to develop and conduct an initial psychometric investigation of a brief measure, the Therapy Attitudes and Process (TAP) Questionnaire, utilising the TPB to understand factors associated with attendance in mental health settings.Design: A quantitative survey based design was utilised. Methods:The TAP was administered to 178 adult participants, who were engaged in individual or group psychotherapy. A subsample also provided data to assess validity and reliability.Results: A four-factor solution was revealed through Exploratory Factor Analysis and accounted for approximately 75% of the variance in scores. Factors corresponded to those predicted by the TPB. Analyses supported the reliability, validity, and internal consistency of the measure. Conclusions:Results suggest that the TAP may provide a useful measure for examining patients' attitudes and beliefs about attending psychotherapy appointments. The TAP can be used to better understand patients' intentions, attitudes, perceptions of behavioural control, and subjective norms relating to psychotherapy attendance. This understanding may facilitate improved outcomes for patients and clinicians. Key Points for Decision Makers:DEVELOPMENT OF THE TAP 3  Non-attendance and dropout is a substantial problem in psychotherapy settings. There is a need to better understand and tailor interventions in accordance with the individual patient barriers. The TAP was developed based on the Theory of Planned Behaviour, and is designed to assess attitudes, subjective norms, perceived behavioural control, and behavioural intentions regarding appointment attendance. Initial investigation of the TAP indicates it has sound psychometric properties and can be used to increase the delivery of patient centered services

Development of the eTAP: A brief measure of attitudes and process in e-interventions for mental health

“…The eTAP was developed based on the TAP (Clough et al, 2016), which measures factors related to client engagement in F2F psychotherapy. It has demonstrated strong psychometric properties, including a clear four factor structure reflecting the four constructs of the TPB, high internal consistency (α ranging from 0.88 to 0.94), and acceptable to good test-retest reliability (0.65 to 0.80) (Clough et al, 2017b).…”

“…Furthermore, none of these measures have been developed in accordance with the guidelines proposed by Fishbein and Ajzen (2010) for measures based on the TPB. One scale, the Therapy Attitudes and Process Questionnaire (TAP) (Clough et al, 2017b), has been validated for use in understanding factors related to adherence to psychotherapy. This scale was developed in line with Ajzen's guidelines for TPB questionnaire construction (Ajzen, 2006), with the exception of including expert but not target group elicitation in the construct of items.…”

“…This scale was developed in line with Ajzen's guidelines for TPB questionnaire construction (Ajzen, 2006), with the exception of including expert but not target group elicitation in the construct of items. The TAP demonstrated strong psychometric properties with regards to validity and reliability, and was designed to be brief enough for regular administration (Clough et al, 2017b). However, the TAP was designed specifically for use in face-to-face (F2F) psychotherapy, and in its current form is not suitable for use in e-interventions.…”

“…The aim of the current study was to report on the development and testing of a scale to understand client adherence to psychological e-interventions. Previous research has demonstrated that the TPB provides a useful framework to understand client adherence to psychological interventions, with the TAP (Clough et al, 2017b) providing a useful measure of this. However, as the TAP was developed specifically for F2F treatment the current research focused on the adaptation and testing of the TAP for use with e-interventions.…”

“…Structural validity was investigated in an exploratory manner, with reference to the performance of items and factors, and the theoretical basis of the model. It was predicted that the measure would demonstrate satisfactory estimates of internal consistency and test-retest reliability, which would be comparable to the original TAP (Clough et al, 2017b) questionnaire. Further, it was hypothesized that the items/factors (depending on emergence of structure) of the eTAP would converge and diverge appropriately, with related constructs, as based on the theoretical underpinnings of the measure (Table 1).…”